Commissioning Support Enhancing Self-Care Medicines use This is an interactive PDF. To navigate, use the arrow buttons on each page or locate a specific section using the tabs and buttons within the document. ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS Contents 03 Introduction 22 Probiotics Indigestion and Heartburn Infrequent Constipation 04 How to use this Interactive PDF 23 Vitamins and Minerals Infrequent Migraine 05 Background to Self-care Insect Bites and Stings 07 Further Reading 24 Self-limiting Conditions Mild Acne 25 Overview 08 Key Contacts Mild Dry Skin 26 Self-limiting Conditions Sunburn Sun Protection 09 GP Guidance Acute Sore Throat Infrequent Cold Sores of the Lip Hay Fever/Seasonal Rhinitis 10 Overview Conjunctivitis Minor Burns and Scalds 11 Guidance for Clinicians Coughs, Colds and Nasal Mild General Aches and Pains Congestion Mouth Ulcers 12 Exceptions to Guidance Cradle Cap (Seborrhoeic Nappy Rash 14 Adult Care Providers Dermatitis – Infants) Oral Thrush Haemorrhoids Prevention of Dental Caries 15 Care Homes Infant Colic Ringworm/Athlete’s Foot/ 16 Patients Receiving Social Care Mild Cystitis Fungal Nail Infection in Community Teething/Mild Toothache 17 OTC Medicines in Schools 50 Self-care Conditions Threadworms and Nurseries 51 Overview Travel Sickness 18 Further Reading Warts and Verrucae 52 Self-care Conditions Mild Irritant Dermatitis 19 Pharmacy Guidance Dandruff 133 Further Support Diarrhoea (Adults) 20 Overview Materials Dry Eyes/Sore (Tired) Eyes 134 National Materials and Earwax Shared Learning 21 Items of Limited Clinical Excessive Sweating (Hyperhidrosis) Effectiveness Head Lice 136 Acknowledgements ENHANCING SELF-CARE MEDICINES USE 2 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS How to use this Interactive PDF Background to Self-care Introduction Further Reading Key Contacts ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 3 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS This implementation tool has been How to use this How to use this developed to aid GPs, pharmacists, other Interactive PDF healthcare professionals and supporting organisations to implement the national Interactive PDF guidance for conditions that can be treated Background to Self-care over-the-counter. • The tool aims to provide a shared perspective and Conditions for which over-the-counter support for the implementation of NHS England’s Further Reading (OTC) items should not routinely be prescribed national self-care agenda and accelerate uptake, enabling commissioners, healthcare professionals in primary care and patients to understand and apply national advice Key Contacts The 2018 NHS England national guidance aims to reduce the routine • The tool has been designed to guide clinicians and prescribing of products for conditions that: organisations through the decisions that need to be made and provide easy access to a variety of • Are considered to be self-limiting, and therefore do not need treatment support materials to increase the uptake of self- as they will get better on their own accord care treatments and strategies by patients, enabling • Lend themselves to self-care i.e. the person suffering does not normally improved use of NHS resources need to seek medical advice and can simply and effectively • Over-the-counter medicines are those that can manage the condition by purchasing over-the-counter items from be sold by local pharmacies, some but not all can their local pharmacy be sold by local supermarkets and other shops. • Can be treated with over-the-counter products in a more cost effective We promote the use of local pharmacies as a manner than via a NHS prescription wider range of products are avaailable and this is • Have little evidence of clinical effectiveness. supported by professional advice • Some of the information contained has been gathered from organisations where previous introduction of self-care strategies has gone well to Each section contains… share learning and reduce duplication across the NHS ✓ Guidance • This tool should be read in conjunction with the national guidance ✓ Contacts for individuals requiring further advice or information • Any information contained within this tool should be used as a guide and tailored to local practice and ✓ Resources and further reading for those who want to patient needs as required. expand their knowledge and understanding ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 4 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS How to use this Interactive PDF Background to Self-care Background to Self-care Why is the NHS promoting self- care? NHS England Chief Executive Simon Stevens said: In the 12 months prior to June 2017, the NHS spent approximately £569 million1 on prescriptions for Across the NHS our aim is to: Further Reading medicines, which could be purchased over-the-counter ‘Think like a patient, act like a (OTC) from a pharmacy and/or other outlets such as taxpayer’. The NHS is probably the petrol stations or supermarkets. most efficient health service in the Key Contacts By reducing spend on treating conditions that are self-limiting, world, but we’re determined to manageable with self-care or for which there is little evidence keep pushing further. Every pound we of clinical effectiveness, resources can be used for other higher save from cutting waste is another priority areas that have a greater impact on patient care and pound we can then invest in better ensure the long-term sustainability of the NHS. A&E care, new cancer treatments and much better mental health services. 1 Refined BSA data to June 2017 ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 5 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS How to use this Interactive PDF Background to Self-care Background to Self-care Key facts about the treatment of self-care conditions in the NHS. The NHS each year spends: What is self-care and why does it matter? Further Reading £22.8m People can play a central role to protect themselves from ill on treating constipation health, by improving or maintaining Key Contacts - enough to fund around healthy lifestyles, choosing the 900 community nurses most appropriate treatment and best managing their long-term £3m conditions. on athlete's foot The term self-care is defined and other fungal as ‘Empowering people with the £5.5m confidence and information to infections – look after themselves when they on mouth ulcers enough to fund can, and visit the GP when they 810 hip operations need to, which gives people greater control of their own health and encourages healthy behaviours that help prevent ill health in the £4.5m on long term’. dandruff shampoos Self-Care Forum £2.8m on £7.5m diarrhoea - enough on indigestion and to fund 2912 heartburn cataract operations ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 6 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS How to use this Interactive PDF Further reading Background to Self-care Key NHS England resources Guidance on conditions for which over the counter items should not routinely be Further Reading prescribed in primary care Conditions for which over the counter items should not be routinely prescribed in primary Key Contacts care: Consultation report of findings Quick ref guide FAQs Other documents Self Care Forum NHS Choices ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 7 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS How to use this Interactive PDF Key contacts Background to Self-care For any enquiries, comments or suggestions regarding this tool please contact: Further Reading Midlands and Lancashire Commissioning Support Unit Paula Wilson Key Contacts [email protected] Daya Singh [email protected] Medicines Management Team [email protected] Clarity Consulting Associates Ltd Shoshana Bloom [email protected] ENHANCING SELF-CARE MEDICINES USE INTRODUCTION 8 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS Overview Guidance for Clinicians GP Guidance Exceptions to Guidance Adult Care Providers Care Homes Patients Receiving Social Care in Community OTC Medicines in Schools and Nurseries Further Reading ENHANCING SELF-CARE MEDICINES USE GP GUIDANCE 9 ITEMS OF LIMITED PHARMACY SELF-LIMITING SELF-CARE FURTHER SUPPORT INTRODUCTION GP GUIDANCE CLINICAL GUIDANCE CONDITIONS CONDITIONS MATERIALS EFFECTIVENESS Overview Overview Guidance for Clinicians The 2018 guidance ‘Conditions for which over-the-counter items should not routinely be prescribed in primary care’ defines conditions that are suitable for treatment via self-care and with products that can be purchased over-the-counter. Exceptions to Guidance A condition that is suitable for self- Clinicians should advise patients care, can be treated with items that of availability of